Racial differences in diuretic therapy, B-type natriuretic peptide values, and prognosis in acute heart failure

Background: Whether variability of B-type natriuretic peptide (BNP) values between races affects its clinical integration as a marker for congestion and predictor of prognosis in acute heart failure (AHF) remains unknown. We aimed to investigate the relationship between diuretic therapy, change in BNP value, and prognosis in AHF in relation to racial differences. Methods: This analysis combined data from the AKINESIS and REALITY-AHF studies. We included White, Black, and Asian individuals admitted with AHF requiring intravenous diuretic therapy. We examined the relative change in BNP values at 48 h post hospital admission, and its association with diuretic therapy and one-year mortality. Results: Of 1380 participants, 29 % were White, 12 % were Black, and 58 % were Asian. Admission BNP values were highest in Black, followed by Asian and White individuals. After adjusting for confounding factors, Black individuals had significantly higher admission BNP values compared to White individuals. During the first 48 h of hospitalization, Asian individuals received the lowest diuretic dose but demonstrated the greatest diuretic response and BNP decrease. After adjustment for confounding factors, Asian individuals were more likely to have a BNP decrease compared to White individuals. Higher admission BNP values predicted higher one-year mortality in White and Asian but not in Black individuals (p for interaction = 0.021). BNP decrease was associated with a lower one-year mortality without a significant interaction by race. Conclusions: In AHF patients, admission BNP was higher in Black, and its decrease after diuretic therapy was greater in Asian individuals. A BNP decrease predicted a better prognosis, regardless of race.